Postmortem Biopsies of the Lung, Heart, Liver, and Spleen of COVID-19 Patients

Abstract

Objective We aimed to evaluate histopathologic alterations in the lung, heart, liver, and spleen of coronavirus disease 2019 (COVID-19) decedents through postmortem core needle biopsies. Materials and methods Patients who died of reverse transcription-polymerase chain reaction-proven COVID-19 were included in this postmortem case series. Postmortem percutaneous ultrasound-guided biopsies of the lungs, heart, liver, and spleen were performed using 14- and 16-gauge needles. Biopsy samples were stained with hematoxylin-eosin and examined under a light microscope. Clinicodemographic characteristics, chest computed tomography (CT) images, and COVID-19-related treatments of the patients were also collected. Results Seven patients were included in this study. Liver and heart tissue samples were available from all patients, and lung and spleen tissue samples were available from five and three patients, respectively. Chest CT images predominantly revealed bibasilar ground-glass opacities. Lung biopsies showed diffuse alveolar damage in all biopsy specimens. Heart findings were nonspecific and largely compatible with the underlying disease. Patchy necrosis, steatosis, and mononuclear cell infiltration were the main findings in the liver biopsies. Splenic histopathological examination showed that splenic necrosis and neutrophil infiltration were common findings in all patients. Conclusion Tissue acquisition was complete for the heart and liver and acceptable for the lungs. The amount of tissue was sufficient for a proper histopathologic examination. Histopathological findings were generally in accordance with previous autopsy studies. Radiological findings of the lung were also correlated with the histopathologic findings. We consider that a postmortem biopsy is a feasible alternative for histopathological examinations in COVID-19 decedents.

Keywords: biopsy; covid-19; heart; histopathologic; liver; lung; postmortem; sars-cov-2; spleen.

Figure 1. Chest CT scan of a 93-year-old male patient who died five days after his CT scan.

A. COVID-19 pneumonia. B. Left-sided hiatal herniation.

Figure 2. Chest CT scan of a 66-year-old female patient.

A. Third chest CT image taken 14 days after the first and seven days after the second CT showing increased GGO in the upper lobes. B. Air bronchograms and GGO accompanying consolidations in the lower lobes. GGO: ground-glass opacities.

Figure 3. Lung microscopy showing the late organizing phase of ARDS.

A. Septal thickening with interstitial cellular increase (x100). B. Septal thickening with interstitial cellular and collagenous increase (x200). C. Interstitial inflammatory cellular infiltration (x400). D. Interstitial thickening with cellular and collagenous increase, atypical type II pneumocyte (orange arrow). ARDS: acute respiratory distress syndrome.

Figure 4. Lung microscopy showing the early phase of ARDS.

A. Hyaline membrane (green asterisk, x400). B. Type II pneumocyte proliferation and alveolar desquamation (x400). C. Microthrombi (blue arrows, x200). D. Microthrombi (blue arrows), type II pneumocyte proliferation, atypical type II pneumocyte (orange arrow), and alveolar desquamation (x400). ARDS: acute respiratory distress syndrome.